Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB # Am REF # <br /> Department of Public Works APN CR' # <br /> EXP. DAT f9 <br /> VALID TO f DRIVEWAYS: <br /> (Applicant Name)f STREET <br /> AREA:!%fr-4 QUAD !` <br /> TYPE NCH <br /> (Mailing Address) FORMS S �•Z <br /> (-'�7—�..d�."1 NOTE <br /> ^. � (City, State, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> C7 <br /> m cn <br /> D <br /> _ w o � <br /> ko PORb Ctc2St1WA. ' Q»vy 7 <br /> + - waltk'94 (}au" f wo wo +fo g%- - rn rJ X <br /> A&II be a,n4ioltaf "4), >> <br /> onf-c0rie. epe.r, and wPP�apcla�e ��� cn cz <br /> /�q1_ <br /> y �►!q� I nJ rNou f S wA CX Caw► <br /> / / <br /> ',A area& 6'k�'I!ICO or `J(Q�C(. M <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the iyUgm- side of <br /> I-iLA46-g_ approximately feet/mile . T� <br /> of Gk-7V#J by performing the <br /> following work (description of work) :Z - " -''- <br /> Work will commence on or about �SE'%z. i[u"P for approximately <br /> & days . <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspectir5n and approval. <br /> Signature, fl Applicant '- Title Date <br /> I <br /> MASTER.PS\PEESCHDL (6/00 <br />